CMS Proposes New Medical Frailty Definition For Medicaid Work Requirement Exemptions

In the interim final rule implementing Medicaid community engagement requirements for the Medicaid expansion population, the Centers for Medicare & Medicaid Services (CMS) proposed a standardized definition of medical frailty. The new standard focuses on whether an individual’s condition significantly impairs the ability to work or participate in community engagement activities.

The current standard has been diagnosis based, and states had freedom to consider other factors such as homelessness when designating an individual as medically frail.

By January 1, 2027, the 43 states and the District of Columbia that expanded Medicaid must ensure that non-exempt beneficiaries ages 19 . . .